A Future Once Deferred: Re-envisioning Men Who Have Sex With Men as Prospective Blood Donors

This thesis examines men who have sex with men (MSM) as a prospective blood donor population in New Zealand, at a time when international and local policy is shifting toward individualised assessments. Three overarching aims guide this work: to descriptively characterize MSM with different donation experiences; to build empirical evidence on predictors of MSM donation behaviour; and to inform future strategies for engaging prospective MSM donors under individualised donor assessment policies. Part 1 reviews the global and local policy landscape and uses previously unpublished national data to describe MSM’s engagement, attitudes, and intentions toward blood donation, establishing the empirical and conceptual foundation for subsequent analyses. Part 2 draws on data from the large-scale Sex and Prevention of Transmission Study (SPOTS) to investigate the diversity, motivations, and social determinants of MSM as (non)donors. Donor segmentation characterized subgroups (non-donors, active donors, and lapsed donors) previously invisible to services, such as MSM who donate without triggering a deferral. More importantly, the papers in this section demonstrate the importance of MSM-specific experiences for understanding how this population engages with blood donation. While persistent negative views of policy were evident, seeing donation as a civic contribution consistently predicted willingness to donate, and sexual identity and community connection significantly predicted noncompliance with the existing deferral policy. Thus, highlighting the central role of MSM-specific experiences and contexts in shaping donation practices. Part 3 applies these insights within a group of MSM who had never donated to inform future engagement. A latent class analysis identified four subgroups differing in eligibility and recruitment potential, importantly showing that eligibility alone does not determine donation. Instead, decisions are shaped by the interplay of identity, behaviour, and attitudes, highlighting the need for tailored engagement strategies. Overall, this thesis advances understanding of MSM as a diverse and heterogeneous donor population. It re-envisions MSM beyond the monolithic framing of “higher-risk” to reveal a population long deferred, marked by varied eligibility, desire, and opportunity to donate. Donation behaviours are inseparable from the social worlds and civic identities in which they are embedded, and these findings provide evidence to guide more inclusive and effective recruitment strategies as New Zealand prepares to implement individualised risk policies.

Name thesis:degree_name

PhD

Level thesis:degree_level

Doctoral

Discipline thesis:degree_discipline

Population Health

Grantor dc:publisher

ResearchSpace@Auckland

Year dc:date.issued

2025

Author dc:creator

• Sriamporn, Koson (Tony)

Advisors dc:contributor.advisor

• Saxton, Peter
• Consedine, Nathan

• blood donation
• msm
• men who have sex with men
• blood donation policy
• hiv
• sexual health

Statement dc:rights

• Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Licence dc:rights.uri

• https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm

Handle dc:identifier.uri

https://hdl.handle.net/2292/76141

OAI identifier oai:identifier

oai:researchspace.auckland.ac.nz:2292/76141